Integration of Clinical Education : Hawaiian Style

Lorrie Wong RN PhD CHSE-AUniversity of Hawaii-Manoa Nursing

Translational Health Science Simulation Center

E Komo mai Aloha

Consortium CurriculumYear 1 and 2 common curriculum among all

partner schoolsYear 3 focus on community global health and

leadership/management

Clinical sitesDecreased availability for acute care clinical

sitesEspecially for pediatrics Competing with other schools of nursing and

new programs within our own school.Solutions:

Increased use of long term care facilitiesIncreased integration of simulation

Ensure all students have exposure to select clinical situations.

Simulation: THSSC MissionTo improve health outcomes by providing programs which promote and enhance safe, quality healthcare through clinical competence, teamwork and inter-professional collaboration.

Purpose or Goal for use of simulation :Deliberate Practice

of a skill- low/mid fidelity manikins

Clinical experience- high fidelity and Simulated Patient experience

Determined Curricular threads (concepts) –high fidelitykey threads

Critical thinkingCommunicationSafetyTeamworkPriority setting & delegationCulture

Determined Selected Critical incidents (mega cases)Determined selected critical incidents that

every student is guaranteed to be exposed to:Department of Health vital statistics and

NCLEX Most common health issues and ethnic desparities

Hawaiian and Pacific Islanders have high incidence of Asthma and COPD common Resp AMI Diabetes type 2

SONDH: THE VILLAGE: Overview

A village of 7 families who reflect the rich cultural diversity of the Hawaiian Islands is currently being created to be used as a framework for simulation and case studies within the curriculumLocation: The families reside in a mix of both rural and urban settings on the islands of Oahu, Kauai, Maui, and the Big Island of Hawaii. Ethinicity/culture: Groups represented include Portuguese, Hawaiian, Chinese/Japanese, Filipino, Caucasian, Micronesian, and African American.

SONDH: THE VILLAGE (Building)

The Process

1. Storyboards, history and physicals, ecomaps, genograms and community surveys are developed for family member.

2. Disease states were selected based on vital statistics obtained from the Hawaii State Department of Health.

3. Content validation: through consultation with at least 2 identified medical experts and cultural leaders.

4. Students encounter these families in simulation activities over the three years of their undergraduate curriculum. Each year the families will evolve and present with new challenges and issues

Key conceptual threads: Concepts threaded into the simulation scenarios include:

• clinical judgment• communication, • Safety• interdisciplinary teamwork• Culture• priority setting and

delegation • ethics.

SONDH: THE VILLAGE: The Families

The Kahue Family are a Hawaiian familyliving in Milolii on the Big Island of Hawaii.The family consists of:• Mrs. Makana Kahue (tutu), her son Keoki Kahue, his wife Makuahine , their two daughters -Haunani 16yo and Leimomi. Haunani has a child named Keoki Jr (1mo).

The Kahue’s have strong Hawaiian cultural ties and practice many of the traditional healing methods. Encounters with the family allow students to about the Hawaiian culture as well as access to care issues for rural communities. Diseases seen in this family include DM 2 with its many complications, Asthma, and obesity. The 16 yo daughter will have a child out of wedlock and they will also “hanai” –unofficially adopt- a child

Hawaii Island“The Big Island”

SONDH: THE VILLAGE

The Gomes family is of Portuguese descent. Mr. Gomes is 54yo and is a smoker who develops COPD and eventually requires home oxygen. Mrs. Gomes is a smoker and develops Pancreatic cancer. They have a son who is “hanai’d” to the Kahue Family. They have two teen children who are in the rebellion phase and experiment with drugs and car racing.

The Russo’s are a Caucasian couple and they dealing with infertility and skin cancer.

KauaiThe Garden Isle

SONDH: THE VILLAGE

Staff Sergeant Tyron Jones lives in Schofield Barracks Military housing with his wife Ashley and their two young daughters Tamika (3yo) and Turrell (1yo). Sgt Jones is African American and his wife is Caucasian. Year 1: Staff Sgt. Jones is deployed and his wife and two children are faced with issues of deploymentYear 2: Staff Sgt returns from deployment suffering from posttraumatic stress disorder and traumatic brain injuryYear 3: students work with Mr. Jones as a divorced vet navigating the VA system.

A Micronesian family are homeless living inKakaako Park. Their 3 children suffer from poor nutrition, failure to thrive and inadequate access to health care.

Oahu: The Gathering Place

Simulated Patients

Interprofessional EducationSessions based on IPEC (2011) Core

Competency Domains These domains are informed by seminal IPE

documents prepared by the IPE workgroup (2011) and others. The four competency domains include:

Values and ethics. Roles, responsibilities, and leadership within the

interprofessional team. Interprofessional communications. Interprofessional team work and team-based

care.

HIPSTER Course DescriptionUsing patient simulation, the setting of

common hospital medical emegencies are used to train a mixed group of nursing, pharmacy, respiratory therapy and medical students in the skills required to work in an optimal interprofessional team.

HIPTCSHawaii Interprofession Team Collaboration

SimulationNursing, Pharmacy, Social work and Medical

Students collaborate to create a culturally appropriate, patient centered discharge plan for a geriatric fall patient.

Number of hours designated for simulationClinical hours vs didactic (lecture hours)

Hawaii has no Board of Nursing regulations Many states in the US have limitations of 25% of

clinical hours can be in simulation Maintain 25-30% maximum (more in first 2 years

and decreased in last year)